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When a pharmacist turns a woman away

A story about a Walmart pharmacist possibly turning a miscarrying woman away for religious reasons may not be what it appeared.
Wal-Mart shopping carts sit outside of a store. (Photo by Justin Sullivan/Getty)
Wal-Mart shopping carts sit outside of a store.

A miscarrying woman was reportedly turned away at a Walmart pharmacy in Georgia, possibly because the pharmacist disapproved of a drug for religious reasons. The story, first reported by WGXA TV in Georgia, seemed to confirm the worst fears of people dismayed by broadening religious exemptions, whether in state-level religious freedom laws or through the Supreme Court's decision in Hobby Lobby

But while so-called "conscience clauses" in states around the country, including in Georgia, already allow pharmacists to opt out of a given prescription — sometimes for any reason at all — there is no evidence that what happened to Brittany Cartrett was an example of that. 

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Cartrett told the station she had miscarried at five or six weeks, and that in consultation with her doctor, she opted for the less invasive procedure of taking medication to manage the miscarriage. She was prescribed two drugs, one of which, misoprostol, Cartrett said the pharmacist refused to fill. When she asked why, Cartrett told WGXA, "She looks at my name and she says oh, well ... I couldn't think of a valid reason why you would need this prescription." 

Because misoprostol is also used to induce abortion early in pregnancy — although in that situation, it's administered at a doctor's office and not a pharmacy — many concluded that the pharmacist disapproved for religious reasons. "Listen, the pill is a pill to assist with abortions. I get it. Make your judgement lady. But she didn't know the whole story and didn't need to know the whole story. Who was she to judge me on what I needed," Cartrett wrote in a widely shared Facebook post. Planned Parenthood cited the case as showing that "women suffer when religion [is] used to deny health care." Amanda Marcotte wrote at Slate, "Appointing a bunch of busybody pharmacists as informal judges over whether you are emptying your uterus for the right reasons is a terrible idea that only compounds the pain of a miscarriage." 

But a spokesman for Walmart, Brian Nick, told msnbc on Monday that the pharmacist had not, in fact, had a religious objection to the drug, but rather believed that it was not medically indicated because it wasn't FDA-approved for miscarriage management, although it is frequently used that way. “The pharmacist exercised professional judgment about the medication and chose not to fill the prescription, and reached out to customer’s doctor and shared that information," Nick said. “This was not a conscientious objection.” 

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When msnbc asked Cartrett what had led her to believe that the pharmacist had refused on religious grounds, she wrote in a message, "I never said that she objected for religious belief other than she 'couldn't think of a reason why I would need it.' Walmart then cited the Georgia law which allows a pharmacist to refuse based on religious or personal beliefs." In other words, it was likely based on a misunderstanding — one compounded by the fact that Cartrett said, "I have yet to get a phone call from Walmart, or to get anyone to return my calls."

Georgia in fact does have a hugely broad pharmacist refusal law, so the pharmacist would have been within her rights to refuse for any reason, religious or otherwise. The law says only, "It shall not be considered unprofessional conduct for any pharmacist to refuse to fill any prescription based on his/her professional judgment or ethical or moral beliefs." 

Nick told msnbc that Walmart's policy has no requirement for a physician to refer a customer to someone who will fill a contested prescription. 

Amy Morton, chairwoman of Better Georgia, a progressive advocacy group, said in a statement, "Regardless of the reason that the Walmart pharmacist gave for refusing to fill the prescription, she should not be able to substitute her judgment for that of the treating physician's. There are women all over Georgia — particularly in rural areas — who don’t have the option of going to another pharmacy if their pharmacist refuses to fill a prescription." 

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A paper published in the "Yale Journal of Health Policy, Law, and Ethics" noted that pharmacists' refusals for religious reasons do happen across the nation — including a widely publicized case in Wisconsin in which one refused to fill a prescription for birth control, and in "California, Georgia, Illinois, Louisiana, Massachusetts, New Hampshire, North Carolina, Ohio, Texas, and Washington ... Some pharmacists will only dispense birth control pills to married women; others refuse to provide the pills to anyone, mistakenly believing emergency contraception to be an abortafacient; still others, like [the pharmacist in Wisconsin], 'hold prescriptions hostage' so that women are unable to take the prescriptions to other pharmacies."